David Sheff On Addiction: Prevention, Treatment And Staying 'Clean'

David Sheff, author of the best-selling Beautiful Boy, researches and reports on the science of addiction. He and his family live in Inverness, Calif.

Bart Nagel
/ Houghton Mifflin Harcourt

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Originally published on March 30, 2013 1:43 pm

David Sheff wrote a book in 2008 that became a kind of landmark. Beautiful Boy was a painful, personal story of the battle he tried to fight with and alongside his son, Nic, who was addicted to methamphetamines. The book became an international best-seller and made David Sheff one of the country's most prominent voices on addiction — not as a doctor, an addict or an academic expert, but as a father.

Sheff has continued to try to figure out a road that can lead out of addiction, and he presents that route in his new book, Clean: Overcoming Addiction and Ending America's Greatest Tragedy. He joined NPR's Scott Simon to talk about prevention, treatment programs and the legalization of marijuana.

Interview Highlights

On the biggest misconception about addiction

"I guess it's this very deeply ingrained idea that addicts are choosing to get high and so they are reprehensible and they're weak. But what we know now is that addicts aren't immoral, they aren't weak; they're ill. They have a disease. And for me, when I finally realized that about Nic, that he was sick, and that's what explained this unconscionable, crazy behavior, it allowed me to look at him with compassion, and to figure out, instead of with anger, just, how do I help him? How do we save his life?"

On why it's crucial to catch addiction early

"This is one of the most complicated diseases there is because this is a brain disease. So the nature of this disease — the thinking is impaired, the self-preservation mechanisms — everything is about getting drugs. It's a biological force. Drugs shift the way that we think. So, yeah, the logical thing would be to get help, but that's not the way addicts operate, which is why it's really, really hard to get someone to understand that they need treatment. If we catch this early, it's not as difficult to get someone into treatment."

On whether addiction is preventable

"I know it's preventable. I mean, the way we've done it in the past doesn't work. 'Just say no' doesn't work. ... Instead, we know that fact-based education works. ... If we learn about the risk factors: stress; certainly if someone has a mental illness, they're more likely to use drugs; if they've experienced some trauma, divorce, in their lives. We have to help kids through those things, and also we have to pay a lot of attention. A doctor that I interviewed said, 'If you think something's wrong, something's wrong.' And that's the time to figure it out, you know, get help. Drag a kid to therapy, if that's what it takes."

On whether legalizing marijuana is a good idea

"Well, actually, I support legalization. But there are a lot of people that support legalization who say things that are just wrong. They say that marijuana should be legalized because it's harmless, you know, it's natural, and no one has ever died from marijuana, you can't get addicted to marijuana — those things are all untrue. Marijuana is not innocuous. There's a lot of research — again, this especially pertains to teenagers. Their brains are developing, marijuana changes the development. ... The effects include problems with their cognition and memory and motivation and there's some evidence that it even lowers IQ. So, I think that we need to legalize pot so we can start a new conversation and deal with this for what it is. It's not a criminal problem and shouldn't be treated as a criminal problem. It's a health problem. So we need to focus on education and not punishment."

On why so many treatment programs fail people

"The only credentials that rehab counselors have in some places is that they're an addict who's in recovery. You want to go into programs that are accredited because they use evidence-based treatments, and so few do. It's really, really hard. And it's why we're losing so many people — 350 people a day are dying from this disease. It's tragic, and it's even more tragic because it's preventable."

On Nic's slow recovery

"When Nic, my son, got addicted — when it was clear he was disappearing, he was stealing from us, he was lying — I got a call from the emergency room, you know, 'Mr. Sheff, you'd better get here. Your son isn't going to make it.' I had no idea what to do. I called people I knew who'd been through this. I looked on the Internet, completely overwhelmed. I ended up making the best decision that I could. It was relying on a friend of a friend of a friend who told me that their child had gone into a program and had done well. I sent Nic there, and at least it got him off the streets. I mean, it didn't stop him from relapsing — he relapsed many times over the course of the next 10 years — but he was off the streets, he got some help. They call this sort of a treatment 'trajectory.' It takes a lot of time for some people, and it takes multiple treatments. Every relapse is dangerous, but often it takes multiple relapses before someone finally gets sober for good."

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SCOTT SIMON, HOST:

David Sheff wrote a book in 2008 that became a kind of landmark. "Beautiful Boy" was a painful, personal story personal story of the battle he tried to fight with and alongside his son, Nic, against his son's addiction to methamphetamines. The book became an international best-seller and made David Sheff one of the country's most prominent voices on addiction - not as a doctor, an addict or an academic expert, but as a father.

David Sheff has continued to try to figure out a road that can lead out of addiction, and he tries to present that route in his new book, "Clean: Overcoming Addiction and Ending American's Greatest Tragedy." David Sheff joins us from the studios of member station KQED in San Francisco. Thanks so much for being with us.

DAVID SHEFF: Oh, Scott, thanks so much for having me.

SIMON: And first, can we ask - how's Nic doing?

SHEFF: Well, he's doing just great. Most importantly, he's sober five years and - which is a miracle. I mean, he nearly died so, so many times. God - he's married, he has a great circle of friends. So, you know, it was unimaginable for a while ago, I mean, I didn't think he was going to make it to 21. But last summer, he turned 30.

SIMON: How good for all of you.

SHEFF: Thank you.

SIMON: What do you think is the first item many of us get wrong about addiction?

SHEFF: Well, I guess it's this very deeply ingrained idea that addicts are choosing to get high and so they are reprehensible and they're, you know, weak. But what we know now is that addicts aren't immoral; they aren't weak. They're ill. They have a disease. And for me, when I finally realized that about Nic - that he was sick; he wasn't, you know - that's what explained this just unconscionable, crazy behavior. It allowed me to look at him with compassion and to figure out, you know, instead of with anger, just how do I help him? How do we save his life?

SIMON: And yet to to help someone or to help them help themselves, isn't it necessary to believe that they - if they didn't choose to become addicted, they can at least make choices that can lift them out of that morass, that they help themselves?

SHEFF: Well, this is one of the most complicated diseases there is because this is a brain disease. So the nature of this disease, the thinking is impaired; the sort of self-preseveration mechanisms, you know - everything is about getting drugs. It's a biological - you know - force. Drugs shift the way that we think. So, yeah, the logical thing would be to get help, but that's not the way addicts operate, which is why it's really, really hard to get someone to understand that they need treatment.

You know, if we catch this early, it's not as difficult to get someone into treatment. Almost every addict started using when they were teenagers. So that's when we want to try to intervene; you know, early stages of just marijuana use, alcohol use, you know. It's a lot easier to prevent things from escalating.

SIMON: Do you think it is preventable?

SHEFF: I know it's preventable. I mean, this - the way we've done it in the past doesn't work. The "just say no" doesn't work. You know, we had police officers coming in, showing pictures of horror stories - you know, a little bit of the "Reefer Madness" kind of era. They show when a drug addict on the street, passed out. And, you know, kids in the audience who are teenagers might smoke some pot at that point, and they just can't relate to that.

So instead, you know, we know that fact-based education works. Parents, teachers and others - if we learn about, you know, the risk factors - stress; certainly, if somebody has mental illness, they're more likely to drugs. If they've experienced some trauma; divorce in their lives. I mean, we have to help kids through those things and also, we have to pay a lot of attention.

A doctor that I interviewed said, you know, if you think something's wrong, something's wrong. And that's the time to figure it out, you know. Get help; drag a kid to therapy, if that's what it takes, to get some advice from a doctor. You find someone who is trained in addiction medicine, and they can put you on a course. There are some treatment programs that use, you know, evidence-based treatment rather than sort of this best guess and pseudo science and, you know, that's the goal.

SIMON: More and more states are legalizing marijuana one way or another, right now. You seem to be skeptical that that's a good idea.

SHEFF: Well, actually, I support legalization. But there's a lot of people that support legalization, who say things that are just wrong. They say that marijuana should be legalized because it's harmless - you know, it's natural, and no one has ever died from marijuana; you can't get addicted to marijuana. Well those things are all untrue.

Marijuana is not innocuous. There's a lot of research - and again, this especially pertains to teenagers. I mean, their brains are developing. Marijuana, you know, changes the development; they can see the difference in the gray matter. There's - the effects include, you know, problems with their cognition and memory and motivation, and there's some evidence that it even lowers IQ. So, you know, I think that we need to legalize pot so we can start a new conversation, and deal with this for what it is. I mean, it's not a criminal problem and shouldn't be treated as a criminal problem. It's a health problem, so we need to focus on education and not punishment.

SIMON: David, what are - in your experience and judgment - some of the reasons that so many treatment programs seem just not to work for people?

SHEFF: Ninety percent of the treatment programs in America are based on the 12-step model. Now, it's really important for me to say that, you know, the 12-steps - you know, Alcoholics Anonymous have saved millions of lives. I mean, it's a really, really profound program.

SIMON: And I mean, I will add - there are people who say that only Alcoholics Anonymous, and that 12-step program, worked.

SHEFF: Right. And so that's where I, you know, that's my problem. I don't object to AA at all - only the programs that insist that it's the only way to get clean and to stay clean.

SIMON: You take on quite a few programs actually, not just AA. What are some of the reasons a lot of treatment programs don't work, in your judgment?

SHEFF: These programs often are run by - the only credentials that rehab counselors have, in some places, is that they're an addict who's in recovery. You want to go into programs that are accredited because they use evidence-based treatments, and so few do. It's really, really hard. And it's why we're losing so many people. You know, 350 people a day are dying from this disease. It's tragic, and it's even more tragic because it is preventable.

When Nic, my son, got addicted - when it was clear he was disappearing, he was stealing from us, he was lying - I got a call from the emergency room; you know, Mr. Sheff, you'd better get here. Your son isn't going to make it. I had no idea what to do. I called people I knew who'd been through this. I looked on the Internet, completely overwhelmed. I ended up making the best decision that I could.

It was relying on a friend of a friend of a friend, who told me that - you know - their child had gone into a program and had done well. I sent Nic there and, you know, at least it got him off the streets. I mean, it didn't stop him from relapsing; he relapsed many times over the course of the next 10 years. But he was off the streets, he got some help. But they call this sort of a treatment trajectory. It takes a lot of time for some people, and it takes multiple treatments. Every relapse is dangerous but often, it takes multiple relapses before someone finally gets sober for good.

SIMON: David Sheff - his new book "Clean: Overcoming Addiction and Ending American's Greatest Tragedy." Thanks very much for speaking with us.

SHEFF: Thanks so much for having me on the show.

(SOUNDBITE OF MUSIC)

SIMON: What are your thoughts about American's addiction problem? You can tweet us @nprweekend and I'm @nprscottsimon. You're listening to WEEKEND EDITION, from NPR News. Transcript provided by NPR, Copyright NPR.